Ventromedially Damaged

I just read Blink, a book about what we subonsciously know before we consciously know something. In it, the author talks a little about studies done on patients with damage to the brain in an area called the ventromedial prefontal cortex, an area of the brain that is critical to making decisions. One of the neurologists who performed these experiments describes trying to set up an appointment with a patient:

"I suggested two alternative dates, both in the coming month and just a few days apart from each other. The patient pulled out his appointment book and began consulting the calendar. The behavior that ensued was remarkable. For the better part of a half an hour, the patient enumerated reasons for and against each of the two dates: previous engagements, proximity to other engagements, possible meteorological conditions, virtually anything that one could think about concerning a simple date. He was walking us through a tiresome cost-benefit analysis, an endless outlining and fruitless comparison of options and possible consequences. It took enormous discipline to listen to all of this without pounding on the table and telling him to stop."

The gist of the book is that sometimes we are able to make decisions, often times the right decisions, without necessarily knowing consciously why they are the right decisions. In a later section, the author describes an experiment where a group of psychologists were asked to consider the case of a particular patient. Each psychologist would be given some information, followed by a multiple choice test about the patient. After the first round, the psychologists would be given more detailed information, and asked to answer the same 25 question multiple choice test. More rounds of the same were repeated. With each new set of information provided, the psychologists reported greater and greater confidence in their answers to the test, changing 9-10 answers with each successive round. But in the end their overall accuracy did not improve. The designer of the experiment commented that as they received more information, "their certainty about their own decisions became entirely out of proportion to the actual correctness of those decisions."

The Bush presidency has been called, and not in a necessarily critical way, the "blink" presidency, based upon the notions that have come from this book. I think there is something to that characterization, for better or for worse. The key insight of the book, it seems to me, is that decisions made in a blink are not always for the worse compared to a more deliberative process, as is typically assumed in the Presidential role. It seemed to me that in the most recent election, for example, Kerry might have been the better able of the two to describe the pros and cons of a given decision, but the less able to actually make a decision. I think the same was true for Clinton. Whereas the errors of these two were (and would most likely be) the result of ommission - simply failing to do anything while you endlessly consider all options, the errors of Bush are likely to be those of commission (though I personally don't think he's made many of these). Democrats suffer from an image of weakness on foreign policy for this very reason - if there is a part of the ventromedial prefrontal cortex that deals with foreign policy, their's is clearly damaged.